What does every person need to be healthy? How does lack of housing or access to nutritious foods undermine a person’s ability to stay healthy? These are questions this community has been asking for decades. And we know the answers. We must invest in housing, jobs, education, nutritious foods, transportation systems – all the things that promote good health. It’s not about charity. It’s a matter of spending our money where we will get the best return – and that means prioritizing our public and private investments in these social determinants of health. But too often, that’s not the way it’s done.

I recall many years ago working with several service providers trying to help a child who was failing to thrive due to malnutrition. For over a year, the child had every possible medical test imaginable to diagnose why the child was not growing. After all that, no answers. And then, we got the child into high quality early care and education, and we paid a grocery store to deliver nutritious food weekly. It wasn’t that hard to orchestrate, and within six weeks, the child no longer needed a one-on-one aide at the center, and the child was thriving. The least costly, least invasive intervention worked. Once the child was no longer hungry all the time, his behavior and his health improved.

I have been watching with interest the current discussion about the future of health care and the need for the health care system to be investing in the upstream social determinants of health – all the things that keep people healthy. These are solid investments that will have a significant return through improved health and lower long-term costs of care, not to mention an improved quality of life for our community members. So I was very pleased to learn that the University of Vermont Health Network proposed continuing its support for local housing, substance abuse, mental health and dental services when it presented its FY15 budget adjustment plan to the Green Mountain Care Board last week. And I am very surprised by the opposition of some lawmakers to the proposal.

Imagine a homeless diabetic being admitted to the hospital 20 times a year in a health crisis because without safe housing, his needles get stolen and he can’t properly refrigerate his insulin. Or patients ready for discharge who have to stay at the hospital for days or weeks because there is no safe place for them to go. This actually happens every day at UVM Medical Center. It is not a good use of health care dollars, but it happens because the non-profit human service agencies have neither the resources nor capacity to provide their effective, less costly upstream services.

In the past two years, our community has begun a focused investment strategy to grow our stock of transitional and permanent supportive housing. UVM Medical Center and United Way of Chittenden County have invested with Champlain Housing Trust and the local Chittenden Homeless Alliance to prioritize housing for the most vulnerable, and the impressive results have inspired us to do even more. Harbor Place and Beacon Apartments are the result. In little more than a year, 66 individuals, most of whom were chronically homeless, are now in safe, stable, supported housing, and they are using the emergency room and in-patient hospital care less. Their quality of life is better. They are no longer at risk of freezing in the cold or dying in an encampment. And it’s saving astonishing amounts of money!

Simply put, if these community programs are successful, there will be less demand for costlier care provided at hospitals, and we will have a healthier community and a more affordable health care system.

State and federal policy makers are asking all of us involved in providing health and human services to shift to a “population health” approach – essentially doing everything we can to make sure everyone has the chance to be healthy and stay out of the hospital. The proposed financial support for community services from the UVM Health Network is exactly the kind of creative thinking needed if this transition is going to be successful.

Martha E. Maksym, of Grand Isle, is executive director of United Way of Chittenden County.

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